Etiopathogenetic Treatment of Patients with Dentofacial Anomalies Against the Background of Disorders in the Architecture of the Oral Cavity Forecourt

Aim and objectives of the study: Improving the effectiveness of diagnostics and comprehensive treatment of patients with dentofacial anomalies against the background of disorders in the architecture of the vestibule of the mouth is relevant, as the frenula of the lips, tongue, and buccal frenula are among the etiological factors in the development of dentofacial anomalies and the cause of relapses after the completion of active orthodontic treatment. Materials and Methods of the Study: 60 individuals with dentofacial anomalies and disorders in the architecture of the oral cavity forecourt were examined and treated, with an important aspect being the plastic surgeries on the vestibule of the mouth. Patients in Groups 1A and 2A underwent plastic surgery for disorders in the architecture of the vestibule of the mouth using the classical method. Patients in Groups 1B and 2B received the proposed correction, where the wound healed by primary tension using palatal grafts. Scientific Novelty: The feature of the clinical course of dentofacial anomalies against the background of disorders in the architecture of the vestibule of the mouth was the pronounced changes in the architecture of the vestibule of the mouth (the height of the attachment of the lip frenulum was less than 5 mm, and in 85.0% (51⁄60) of patients, buccal frenula were present in the area of the incisors and premolars). The results of cytomorphometric and reographic studies indicated a deficiency in blood supply in these areas. The clinical and laboratory examination results showed a significant difference between surgical interventions, where the wound healed by primary and secondary tension. The long-term results after the proposed method of correcting disorders in the architecture of the vestibule of the mouth and the use of Gengigel in the postoperative period indicated the formation of a normotrophic scar, the absence of relapses and the formation of gingival recession in the projection areas of the buccal frenula, as well as the normalization of clinical and laboratory indicators. The obtained data significantly differ from the indicators in other patient groups (p < 0.05). Conclusions: A detailed examination of the oral cavity forecourt during treatment planning for patients with dentofacial anomalies is an important diagnostic component. Since abnormally fixed buccal frenula are often a prerequisite for changes in tooth position, disruption of blood supply in the areas where they are located, the appearance of gingival recessions, and hypertonia in the area of the circular muscle of the mouth. Preventive plastic surgery of the buccal frenula prevents the onset of these pathological conditions. The use of the technique we proposed, combined with the use of Gengigel in the postoperative period, ensures the formation of normotrophic scars and the restoration of blood supply in the vestibule of the mouth.